Autoimmune gastritis: clinical picture, diagnosis, treatment

DOI: https://doi.org/10.29296/25877305-2023-12-18
Issue: 
12
Year: 
2023

L. Abduragimova; I. Khlynov, MD; R. Khlynova; G. Moroz
Ural State Medical University, Ministry of Health of Russia, Yekaterinburg

The review includes the analysis of modern data about prevalence, clinical picture, endoscopic, morphological, immunological diagnosis and treatment of autoimmune gastritis (AIG). The incidence of AIG is 2–12% of all cases of chronic gastritis. The leading factor in pathogenesis is the formation of autoantibodies to parietal cells and intrinsic Castle factor. AIG is a significant risk factor for vitamin C, B12, and D deficiency. The clinical picture of AIG is nonspecific and may include gastroenterologic, hematologic, and neuropsychiatric syndromes. Morphological diagnosis is the most reliable method for assessing atrophic gastritis, allowing the assessment of the three dynamic stages of AIG. Immunological diagnostics include antibodies to parietal cells and are highly specific. There is no etiotropic and pathogenetic therapy for AIG. Cyanocobalamin replacement therapy is approved in clinical practice.
Keywords: 
autoimmune gastritis
clinical picture
diagnostic standards
comorbidity
replacement therapy.

References: 
  1. Lenti M.V., Rugge M., Lahner E. et al. Autoimmune gastritis. Nat Rev Dis Primers. 2020; 6 (1): 56. DOI: 10.1038/s41572-020-0187-8
  2. Toh B.H. Diagnosis and classification of autoimmune gastritis. Autoimmun Rev. 2014; 13 (4-5): 459–62. DOI: 10.1016/j.autrev.2014.01.048
  3. Silveira P.A., Wilson W.E., Esteban L.M. et al. Identification of the Gasa3 and Gasa4 autoimmune gastritis susceptibility genes using congenic mice and partitioned, segregative and interaction analyses. Immunogenetics. 2001; 53 (9): 741–50. DOI: 10.1007/s00251-001-0391-y
  4. Lahner E., Spoletini M., Buzzetti R. et al. HLA-DRB1*03 and DRB1*04 are associated with atrophic gastritis in an Italian population. Dig Liver Dis. 2010; 42 (12): 854–9. DOI: 10.1016/j.dld.2010.04.011
  5. Oksanen A.M., Haimila K.E., Rautelin H.I. et al. Immunogenetic characteristics of patients with autoimmune gastritis. World J Gastroenterol. 2010; 16 (3): 354–8. DOI: 10.3748/wjg.v16.i3.354
  6. Song H., Held M., Sandin S. et al. Increase in the Prevalence of Atrophic Gastritis Among Adults Age 35 to 44 Years Old in Northern Sweden Between 1990 and 2009. Clin Gastroenterol Hepatol. 2015; 13 (9): 1592–600.e1. DOI: 10.1016/j.cgh.2015.04.001
  7. Волынец Г.В. Клинические и диагностические особенности и принципы терапии аутоиммунного гастрита у детей. Детская гастроэнтерология. 2005; 3: 33–7 [Volynets GV. Clinical and diagnostic features and principles of therapy for autoimmune gastritis in children. Pediatric gastroenterology. 2005; 3: 33–7 (in Russ.)].
  8. Youssefi M., Tafaghodi M., Farsiani H. et al. Helicobacter pylori infection and autoimmune diseases; Is there an association with systemic lupus erythematosus, rheumatoid arthritis, autoimmune atrophy gastritis and autoimmune pancreatitis? A systematic review and meta-analysis study. J Microbiol Immunol Infect. 2021; 54 (3): 359–69. DOI: 10.1016/j.jmii.2020.08.011
  9. D'Elios M.M., Appelmelk B.J., Amedei A. et al. Gastric autoimmunity: the role of Helicobacter pylori and molecular mimicry. Trends Mol Med. 2004; 10 (7): 316–23. DOI: 10.1016/j.molmed.2004.06.001
  10. Rodriguez-Castro K.I., Franceschi M., Miraglia C. et al. Autoimmune diseases in autoimmune atrophic gastritis. Acta Biomed. 2018; 89 (8-S): 100–3. DOI: 10.23750/abm.v89i8-S.7919
  11. Kahaly G.J., Hansen M.P. Type 1 diabetes associated autoimmunity. Autoimmun Rev. 2016; 15 (7): 644–8. DOI: 10.1016/j.autrev.2016.02.017
  12. Jevremovic D., Torbenson M., Murray J.A. et al. Atrophic autoimmune pangastritis: A distinctive form of antral and fundic gastritis associated with systemic autoimmune disease. Am J Surg Pathol. 2006; 30 (11): 1412–9. DOI: 10.1097/01.pas.0000213337.25111.37
  13. Massironi S., Zilli A., Elvevi A. et al. The changing face of chronic autoimmune atrophic gastritis: an updated comprehensive perspective. Autoimmun Rev. 2019; 18 (3): 215–22. DOI: 10.1016/j.autrev.2018.08.011
  14. Carabotti M., Lahner E., Esposito G. et al. Upper gastrointestinal symptoms in autoimmune gastritis: A cross-sectional study. Medicine (Baltimore). 2017; 96 (1): e5784. DOI: 10.1097/MD.0000000000005784
  15. Miceli E., Lenti M.V., Padula D. et al. Common features of patients with autoimmune atrophic gastritis. Clin Gastroenterol Hepatol. 2012; 10 (7): 812–4. DOI: 10.1016/j.cgh.2012.02.018
  16. Tenca A., Massironi S., Pugliese D. et al. Gastro-esophageal reflux and antisecretory drugs use among patients with chronic autoimmune atrophic gastritis: a study with pH-impedance monitoring. Neurogastroenterol Motil. 2016; 28 (2): 274–80. DOI: 10.1111/nmo.12723
  17. Hershko C., Patz J., Ronson A. The anemia of achylia gastrica revisited. Blood Cells Mol Dis. 2007; 39 (2): 178–83. doi: 10.1016/j.bcmd.2007.03.006
  18. Yang G.T., Zhao H.Y., Kong Y. et al. Correlation between serum vitamin B12 level and peripheral neuropathy in atrophic gastritis. World J Gastroenterol. 2018; 24 (12): 1343–52. DOI: 10.3748/wjg.v24.i12.1343
  19. Rodriguez-Castro K.I., Franceschi M., Noto A. et al. Clinical manifestations of chronic atrophic gastritis. Acta Biomed. 2018; 89 (8-S): 88–92. DOI: 10.23750/abm.v89i8-S.7921
  20. Cavalcoli F., Zilli A., Conte D. et al. Micronutrient deficiencies in patients with chronic atrophic autoimmune gastritis: A review. World J Gastroenterol. 2017; 23 (4): 563–72. DOI: 10.3748/wjg.v23.i4.563
  21. Di Sabatino A., Lenti M.V., Giuffrida P. et al. New insights into immune mechanisms underlying autoimmune diseases of the gastrointestinal tract. Autoimmun Rev. 2015; 14 (12): 1161–9. DOI: 10.1016/j.autrev.2015.08.004
  22. Miceli E., Padula D., Lenti M.V. et al. A laboratory score in the diagnosis of autoimmune atrophic gastritis: a prospective study. J Clin Gastroenterol. 2015; 49 (1): e1–5. DOI: 10.1097/MCG.0000000000000101
  23. Neumann W.L., Coss E., Rugge M. et al. Autoimmune atrophic gastritis – pathogenesis, pathology and management. Nat Rev Gastroenterol Hepatol. 2013; 10 (9): 529–41. DOI: 10.1038/nrgastro.2013.101
  24. Lenti M.V., Miceli E., Padula D. et al. The challenging diagnosis of autoimmune atrophic gastritis. Scand J Gastroenterol. 2017; 52 (4): 471–2. DOI: 10.1080/00365521.2016.1275771
  25. Rusak E., Chobot A., Krzywicka A. et al. Anti-parietal cell antibodies – diagnostic significance. Adv Med Sci. 2016; 61 (2): 175–9. DOI: 10.1016/j.advms.2015.12.004
  26. Zagari R.M., Rabitti S., Greenwood D.C. et al. Systematic review with meta-analysis: diagnostic performance of the combination of pepsinogen, gastrin-17 and anti-Helicobacter pylori antibodies serum assays for the diagnosis of atrophic gastritis. Aliment Pharmacol Ther. 2017; 46 (7): 657–67. DOI: 10.1111/apt.14248
  27. Conti L., Lenti M.V., Di Sabatino A. et al. Seronegative autoimmune atrophic gastritis is more common in elderly patients. Dig Liver Dis. 2020; 52 (11): 1310–4. DOI: 10.1016/j.dld.2020.04.015
  28. Zhang C., Huang Y., Long J. et al. Serum chromogranin A for the diagnosis of gastroenteropancreatic neuroendocrine neoplasms and its association with tumour expression. Oncol Lett. 2019; 17 (2): 1497–504. DOI: 10.3892/ol.2018.9795
  29. Tian T., Gao J., Li N. et al. Circulating Chromogranin A as A Marker for Monitoring Clinical Response in Advanced Gastroenteropancreatic Neuroendocrine Tumors. PLoS One. 2016; 11 (5): e0154679. DOI: 10.1371/journal.pone.0154679
  30. Kato M., Uedo N., Toth E. et al. Differences in image-enhanced endoscopic findings between Helicobacter pylori-associated and autoimmune gastritis. Endosc Int Open. 2021; 9 (1): E22-E30. DOI: 10.1055/a-1287-9767
  31. Pimentel-Nunes P., Dinis-Ribeiro M., Soares J.B. et al. A multicenter validation of an endoscopic classification with narrow band imaging for gastric precancerous and cancerous lesions. Endoscopy. 2012; 44 (3): 236–46. DOI: 10.1055/s-0031-1291537
  32. Park J.Y., Lam-Himlin D., Vemulapalli R. Review of autoimmune metaplastic atrophic gastritis. Gastrointest Endosc. 2013; 77 (2): 284–92. DOI: 10.1016/j.gie.2012.09.033
  33. Zullo A., Hassan C., Romiti A. et al. Follow-up of intestinal metaplasia in the stomach: When, how and why. World J Gastrointest Oncol. 2012; 4 (3): 30–6. DOI: 10.4251/wjgo.v4.i3.30
  34. Coati I., Fassan M., Farinati F. et al. Autoimmune gastritis: Pathologist's viewpoint. World J Gastroenterol. 2015; 21 (42): 12179–89. DOI: 10.3748/wjg.v21.i42.12179
  35. Stabler S.P. Vitamin B12 deficiency. N Engl J Med. 2013; 368 (21): 2041–2. DOI: 10.1056/NEJMc1304350
  36. Aditi A., Graham D.Y. Vitamin C, gastritis, and gastric disease: a historical review and update. Dig Dis Sci. 2012; 57 (10): 2504–15. DOI: 10.1007/s10620-012-2203-7
  37. Henry E.B., Carswell A., Wirz A. et al. Proton pump inhibitors reduce the bioavailability of dietary vitamin C. Aliment Pharmacol Ther. 2005; 22 (6): 539–45. DOI: 10.1111/j.1365-2036.2005.02568.x
  38. Recker R.R. Calcium absorption and achlorhydria. N Engl J Med. 1985; 313 (2): 70–3. DOI: 10.1056/NEJM198507113130202
  39. Chonan O., Takahashi R., Yasui H. et al. Effect of L-lactic acid on calcium absorption in rats fed omeprazole. J Nutr Sci Vitaminol (Tokyo). 1998; 44 (3): 473–81. DOI: 10.3177/jnsv.44.473
  40. Eastell R., Vieira N.E., Yergey A.L. et al. Pernicious anaemia as a risk factor for osteoporosis. Clin Sci (Lond). 1992; 82 (6): 681–5. DOI: 10.1042/cs0820681
  41. Antico A., Tozzoli R., Giavarina D. et al. Hypovitaminosis D as predisposing factor for atrophic type A gastritis: a case-control study and review of the literature on the interaction of Vitamin D with the immune system. Clin Rev Allergy Immunol. 2012; 42 (3): 355–64. DOI: 10.1007/s12016-011-8255-1
  42. Ивашкин В.Т. Гастроэнтерология. Национальное руководство под ред. Ивашкина В.Т., Лапиной Т.Л. М.: ГЭОТАР-Медиа, 2018; 464 с. [IvashkinV.T. Gastroenterology. National leadership. Ed. Ivashkin V.T., Lapin T.L. Moscow: GEOTAR-Media, 2018; 464 p. (in Russ.)].
  43. Ивашкин В.Т., Маев И.В., Ивашкин К.В. и др. Роль нарушения защитных факторов в развитии кислотозависимых заболеваний (Резолюция Экспертного совета 12-13 марта 2016). Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2016; 26 (3): 115–6 [Ivashkin V.T., Maev I.V., Ivashkin K.V. et al. The role of violation of protective factors in the development of acid-related diseases (Resolution of the Expert Council on March 12-13, 2016). Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2016; 26 (3): 115–6 (in Russ.)]. DOI: 10.22416/1382-4376-2016-26-3-115-116
  44. Хлынов И.Б., Чикунова М.В. Значение слизисто-бикарбонатного барьера желудка при кислотозависимых заболеваниях. РМЖ. 2016; 17: 1125–9 [Khlynov I.B., Chikunova M.V. The importance of the mucous-bicarbonate barrier of the stomach in acid-dependent diseases. RMJ. 2016; 17: 1125–9 (in Russ.)].
  45. Кручинина Т.В., Махова А.А., Ших Е.В. и др. S-метилметионин (витамин U): экспериментальные исследования и клинические перспективы. Вопросы питания. 2018; 87 (5): 70–6 [Kruchinina T.V., Makhova A.A., Shikh E.V. et al. S-methylmethionin (vitamin U): experimental studies and clinical perspective). Problems of Nutrition. 2018; 87 (5): 70–6 (in Russ.)]. DOI: 10.24411/0042-8833-2018-10055
  46. Asha D. Patel and N. К. Prajapati. Review on Biochemical Importance of Vitamin-U. Journal of Chemical and Pharmaceutical Research. 2012; 4 (1): 209–15.
  47. Ichikawa T., Ito Y., Saegusa Y. et al. Effects of combination treatment with famotidine and methylmethionine sulfonium chloride on the mucus barrier of rat gastric mucosa. J Gastroenterol Hepatol. 2009; 24 (3): 488–92. DOI: 10.1111/j.1440-1746.2008.05667.x
  48. Харкевич Д.А. Фармакология. М.: ГЭОТАР-Медиа, 2010; с. 475 [Kharkevich D.A. Pharmacology. M.: GEOTAR-Media, 2010; р. 475 (in Russ.)].
  49. Голованова Е.С. Клинический эффект и анализ некоторых сторон механизма действия отечественного препарата витамина U (S-метилметионина) при язвенной болезни. Пермь, 1974 [Golovanov E.C. Clinical effect and analysis of some aspects of the mechanism of action of the domestic preparation of vitamin U (S-methylmethionine) in peptic ulcer disease. Perm, 1974 (in Russ.)].
  50. Топчий Н.В., Топорков А.С. Метилметионинсульфония хлорид в комплексных лечебных и профилактических программах при заболеваниях гастродуоденальной зоны. Медицинский совет. 2019; 3: 60–8 [Topchiy N.V., Toporkov A.S. Metilmetioninsulfoniya chloride in the complex of therapeutic and prophylactic programs at diseases of gastroduodenal zone. Medical Council. 2019; 3: 60–8 (in Russ.)]. DOI: 10.21518/2079-701X-2019-3-60-68
  51. Дроздов В.Н., Ших Е.В., Стародубцева А.К. и др. Хронический гастрит и идиопатическая пептическая язва, перспективы применения S-метилметионина (витамин U) в комплексной терапии. Трудный пациент. 2018; 6 (16): 12–8 [Drozdov V.N., Shikh E.V., Starodubtseva A.K. et al. Chronic gastritis and idiopathic peptic ulcer, prospects for the use of S-methylmethionine (vitamin U) in complex therapy. Difficult Patient. 2018; 6 (16): 12–8 (in Russ.)].
  52. Пахомова И.Г. Возможности применения метилметионинсульфония хлорида как компонента комбинированной терапии язвенной болезни и гастродуоденитов. Медицинский совет. 2018; 14: 28–32 [Pakhomova I.G. Potential use of methylmethionine sulfonium chloride as a component of combination therapy for peptic ulcer and gastroduodenitis. Medical Council. 2018; 14: 28–32 (in Russ.)]. DOI: 10.21518/2079-701X-2018-14-28-32
  53. Watanabe T., Ohara S., Ichikawa T. et al. Mechanisms for cytoprotection by vitamin U from ethanol-induced gastric mucosal damage in rats. Dig Dis Sci. 1996; 41 (1): 49–54. DOI: 10.1007/BF02208583
  54. Watanabe T., Ohara S., Miyazawa S. et al. Augmentative effects of L-cysteine and methylmethionine sulfonium chloride on mucin secretion in rabbit gastric mucous cells. J Gastroenterol Hepatol. 2000; 15 (1): 45–52. DOI: 10.1046/j.1440-1746.2000.02037.x
  55. Дроздов В.Н., Ших Е.В., Астаповский А.А. и др. Влияние 6-месячного приема S-метилметионина на качество жизни и симптомы диспепсии у пациентов с хроническим гастритом. Вопросы питания. 2023; 92 (2): 80–6 [Drozdov V.N., Shih E.V., Astapovskij A.A. et al. Effect of 6-month S-methylmethionine intake on the quality of life and dyspepsia symptoms in patients with chronic gastritis. Problems of Nutrition. 2023; 92 (2): 80–6 (in Russ.)]. DOI: 10.33029/0042-8833-2023-92-2-80-86